Student Certification of Business Hours

NCUA
National Credit Union Administration

Student Internship Certification of Business Hours (Hours
Worked) Form
This form must be completed by each student intern that was paid by a credit
union requesting to receive reimbursement under the Student Internship Initiative
of the National Credit Union Administration (NCUA) Office of Small Credit
Union Initiatives (OSCUI) Grant Program.
Credit unions are responsible for submitting this form for each intern with their
request for reimbursement. The online grant reimbursement request will prompt
applicable credit unions to upload this completed form.
This completed form serves as proof of purchase/payment for the Student
Internship Initiative.
1. Credit Union Name:
2. Charter#:
3. Name of Intern:
4. Intern Contact Email
Address:
5. Authorized Intern
Signature:
6. Dates of Internship:
7. Total Hours Worked by
Intern:
8. Hourly Rate Paid to Intern
(maximum $10/hr)
9. Total Reimbursement
Requested for Internship
(maximum $4,000 for all
interns combined)

*Items 7 * Item 8 Must = Item 9

1